Provider Demographics
NPI:1376965657
Name:MEEHAN, JOHN PATRICK (BS, LADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:MEEHAN
Suffix:
Gender:M
Credentials:BS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 MAIN ST
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6844
Mailing Address - Country:US
Mailing Address - Phone:563-588-2464
Mailing Address - Fax:563-582-4006
Practice Address - Street 1:799 MAIN ST
Practice Address - Street 2:SUITE # 110
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6844
Practice Address - Country:US
Practice Address - Phone:563-582-3784
Practice Address - Fax:563-582-4006
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302467101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)